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Objectives To explore occupational and psychological risk factors for the incidence and persistence of multi-site musculoskeletal pain. Methods We conducted a longitudinal investigation of three occupational groups in Crete, Greece. Baseline information was obtained at interview about pain in the past year at each of six anatomical sites, and about possible risk factors for subsequent symptoms. Twelve months later, subjects were re-interviewed about pain at the same anatomical sites in the past month. Pain at two or more sites was classed as multi-site. Associations with new development and persistence of multi-site pain at follow-up were assessed by logistic regression. Results Analysis was based on 518 subjects (87% of those originally selected for study). At follow-up, multi-site pain persisted in 217 (62%) of those who had experienced it in the year before baseline, and was newly developed in 27 (17%) of those who had not. Persistence of multi-site pain was significantly related to physical loading at work, somatising tendency and beliefs about work as a cause of musculoskeletal pain, with OR (95% CI) for the highest relative to the lowest exposure categories of 2.3 (1.0 to 5.6), 2.6 (1.5 to 4.6) and 1.9 (1.1 to 3.3) respectively. Development of new multi-site pain was most strongly associated with working for ≥40 h per week (OR 5.0, 95% CI 1.1 to 24.0). Conclusions Our findings confirm the importance of both physical loading at work and somatising tendency as risk factors for multi-site pain, and suggest that persistence of pain is also influenced by adverse beliefs about work causation.

Objectives Exposure to disinfection by-products (DBPs) during pregnancy has been associated with adverse birth outcomes. We evaluated exposure to DBPs through ingestion, inhalation and dermal absorption among pregnant women in Crete, in relation to birth weight and gestational age. Methods The mother–child birth cohort in Crete (‘Rhea’ study) enrolled 1359 pregnant women at the third month of pregnancy (2007–2008), residents in the prefecture of Heraklion. Exposures were assessed through three questionnaires administered during pregnancy requesting extensive information on personal water-related habits. Tap water samples were collected in representative mother homes on the basis of detailed water distribution patterns, and were analysed for major DBPs including trihalomethanes (THMs). Logistic and linear regression models were applied. Results Pregnant women reported a high consumption of bottled water at home (76%) and work (96%). More than half the women (59%) washed dishes by hand, nearly all women (94%) took showers rather than baths (1%), and only 2% attended a swimming pool. THM levels were low (

Objectives To assess the prevalence of new onset and persistent multisite musculoskeletal pain in three occupational groups, and identify potential risk factors. Methods Our study sample consisted of nurses, postal clerks and office workers (N=596). Structured personal interviews were done at two time points: at baseline and at follow-up 1 year later. We inquired about pain in the low back, neck, shoulder, elbow, wrist/hand and knee, and about demographic, individual and occupational characteristics. We defined multisite pain as pain in two or more body sites, and identified two health outcomes: new onset and persistent multisite pain. We applied logistic regression and calculated ORs adjusted for potential confounding factors. Results 518 subjects participated in both phases (response rate 87%). Sixty-eight percent of participants reported multisite pain at baseline and of those, 62% also reported multisite pain at follow up. The incidence of new onset multisite pain was 16%. Forty or more hours per week at work was significantly associated with new onset multisite pain (OR 5.0, 95% CI 1.1 to 24.0). Heavy physical load (OR 5.1, 95% CI 2.1 to 12.2), very low mood (1.9, 1.0 to 3.2), increased somatising tendency (3.3, 1.9 to 5.5), and strong work causation beliefs (2.2, 1.3 to 3.8) seemed to predict persistence of multisite pain at follow up. Conclusions Persistent multisite pain was common in our study sample and was predicted both by occupational and individual factors. New onset multisite pain was predicted by hours per week at work.

Recent epidemiological and experimental studies have suggested that persistent organochlorine compounds (OCs) such as polychlorinated biphenyls (PCBs) and dioxins may alter thyroid hormone levels in animals and humans. As neurological development occurs in discrete developmental windows, even transient disorders in thyroid hormone availability can have profound effects on brain development.1 Most studies have focused on the effects of prenatal exposure, but little evidence exists concerning the effects of exposure to OCs during childhood. Further research on the latter is reported in a paper by Alvarez-Pedrerol et al in this issue ( see page 452 ).2 Exposure to certain OCs such as dichlorodiphenyl trichloroethane (p,p′-DDT), β-hexachlorocylcohexane (β-HCH) and polychlorinated biphenyls (congeners PCB-138, PCB-153 and PCB-118) …